From the Guidelines
High blood pressure should be diagnosed based on repeated office blood pressure measurements on more than one visit, with three measurements recorded at each visit, or through out-of-office blood pressure measurement with ambulatory blood pressure monitoring (ABPM) and/or home blood pressure monitoring (HBPM) if feasible. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1, diagnosing hypertension involves taking multiple blood pressure readings. At each visit, three blood pressure measurements should be recorded, 1–2 min apart, and additional measurements should be performed if the first two readings differ by >10 mmHg. The patient’s blood pressure is the average of the last two blood pressure readings.
When screening office blood pressure is ≥160/100 mmHg, it is recommended that blood pressure 160–179/100–109 mmHg be confirmed as soon as possible (e.g. within 1 month) preferably by either home or ambulatory blood pressure measurements 1. If blood pressure is ≥180/110 mmHg, it is essential to exclude hypertensive emergency.
Some key points to consider when diagnosing high blood pressure include:
- Repeated office blood pressure measurements on more than one visit
- Out-of-office blood pressure measurement with ABPM and/or HBPM if feasible
- Confirming high blood pressure readings through additional measurements
- Excluding hypertensive emergency in cases of severely elevated blood pressure
- Using the average of the last two blood pressure readings to determine the patient’s blood pressure.
It is crucial to follow these guidelines to ensure accurate diagnosis and appropriate management of high blood pressure, as outlined in the 2024 ESC guidelines 1.
From the Research
Diagnosing High Blood Pressure
To diagnose high blood pressure, the following steps can be taken:
- Take multiple blood pressure readings, as a single measurement is not sufficient for diagnosis 2
- Measure blood pressure during the afternoon, as this gives the best agreement with the 24-hour blood pressure mean 2
- Take 8-10 blood pressure readings between 1:00 and 5:00 p.m. to get a clinically useful approximation of the daytime mean blood pressure 2
Secondary Hypertension
It's also important to consider secondary hypertension, which can be caused by underlying conditions such as:
- Primary aldosteronism
- Renovascular hypertension
- Pheochromocytoma and paraganglioma
- Cushing's syndrome
- Obstructive sleep apnea 3 Early detection of secondary hypertension is crucial, as it can be cured or better controlled with proper diagnosis and treatment 3
Blood Pressure Targets
The target blood pressure for diagnosis and treatment can vary depending on the individual and their health status:
- For most adults, the target blood pressure is less than 130/85 mmHg 4
- For individuals with diabetes, renal insufficiency, or heart failure, the target blood pressure may be lower, such as less than 125/75 mmHg 4
Treatment Options
There are various treatment options available for high blood pressure, including: